Complex Wound Mold Step by Step Instructions

Purulent draining wound #

To create a wound that can simulate a purulent drain, follow the same steps needed for a simple wound, while keeping in mind the need for space to create a cavity during the silicone-pouring step.

Using clay, make a wound that is slightly ‘inflamed’ or ‘puffy’. The rest of the surface and texture can be whatever you need to meet your objectives.

As with the simple wound process [LINK], surround the clay with a wall of clay, and fill with mold making material (Smooth Cast or other)

Prepare for the silicone-pouring step [LINK], with one extra step before the actual pour: take a small amount of clay and roll up in a small log, place it at the lowest point of the mold, making sure it is not ‘higher’ than the highest point of the mold. Otherwise, the finished appliance will have a hole on the surface touching the manikin/Standardized Patient. This will later become the cavity you fill with ‘pus’ or other substance.

Pour the silicone into the mold, making sure the clay log is completely covered. Once the silicone has cured, demold the appliance. You may observe the clay log is encapsulated in the silicone, simply make an incision to remove it. This opening can now be sutured closed or left open.

Using a small cup, mix petroleum jelly and food colouring to achieve the desired look for the substance you are trying to recreate. Taking a syringe (10cc or 20cc work well), remove the plunger. Then, using a tongue depressor, scoop the petroleum jelly into the syringe. Replace the plunger and push contents to the end. Using a blunt tip cannula, inject the petroleum jelly into the wound until some oozes out of the wound.

Note that it may be difficult to push the thick petroleum jelly out of the blunt tip cannula.

Burns #

Burns can add a level of complexity to simulation that can increase the level of ‘buy-in’ learners have in the simulated case. To make it easier, and more cost effective, it is possible to prep burnt skin ahead of time.

Using Dragon Skin FX-pro, silc pig colour pigment, and Thivex silicone thickener: mix the silicone and pigment to have the desired look Adding Thivex will make the silicone thicker, which allows it to be brushed on to a surface and not drip off.

With the silicone mixture ready, apply to the manikin or stable surface of your choice. Wait for the silicone to cure before peeling off from the manikin/stable surface.

Placed on the manikin when needed.

Optional: Add makeup and fake soot on to increase realism.

Undermining/tunneling wounds #

Wounds with undermining and tunneling can pose a challenge to health care workers and increase the risk of infection, necrosis, and longer recovery for the patient. To simulate such a wound, follow these steps:

For this type of wound appliance, using a small bowl is recommended. Using clay, create the shape the internal undermining or tunneling will look like. Make sure the base of this clay structure sits in the middle of the bowl

It is possible to add texture to the finished wound by adding texture to the clay at this point in the process. Once the clay sculpting is complete, move on to the silicone stage where a few options are possible. Ideally, you would have Dragon

Skin, Thivex, Silc Pig, and Flex Foam It X.

Using skin tone pigment silicone, pour an initial layer in the bottom of the bowl to surround the clay structure. This will be the skin layer on the surface of this wound trainer.

Once that initial layer of silicon has cured, prepare another batch of silicone, this time with a red colour to simulate the tissue below the surface of the skin (if adipose tissue is desired, follow the same steps at the skin layer, but with yellow pigmentation). Once the desired colour is achieved, mix in some Thivex to thicken the silicone.

Once thickened, brush the silicone on the inside walls of the bowl and on the clay structure. Once this silicone has cured, you should have a bowl with the inside walls and clay structure completely covered in silicone.

Prep Flex Foam It X (if available) and pour into the empty space of the bowl. Once the foam is cured, trim the excess off with a knife.

To ‘close’ this wound trainer, prepare a smaller amount of silicone, and (optional) match the skin colour. Pour the silicone on a flat surface, and place the bowl over it (foam side down).

Once this silicone has cured, remove the whole thing from the bowl and trim off the excess silicone.

Bleeding wound #

It is possible to create a wound that can ‘bleed’ and require intervention to stop the bleeding. Bleeding is done by filling a syringe with red coloured water and pushing that through tubing, or even by adding food colouring to a saline bag and attaching the tubing to the wound tubing.

Before shaping the clay into a wound, get a length of tubing. An extension set with Luer lock on either end works well. Cut off the ‘male’ end of the tubing, as you will need the ‘female’ end to attach the syringe. Add clay around the tubing, with the end of the tubing pointing sticking out of the clay.

Once you are finished sculpting the clay as desired, carefully remove the tubing. Twisting it, moving it in and out slowly, etc. The goal is to remove the tube without affecting the look of the wound too much. Prep your wall of clay around the wound.

Prepare your casting material and pour into the wound, making sure the hole for the tubing is filled in. Once the casting material has cured, remove the clay. There should now be a ’tube’ like structure as part of your mold.

One more step is required before the mold is ready. If you were to pour silicone in the mold now, it would be impossible to remove it since the ’tube’ structure would trap the silicone to the mold.

To be able to remove the silicone appliance, you need to cut the section of ’tubing’ where it connects to the ’top surface’ of the mold.

So now when you have cured silicone, you may need to make a small incision in the silicone, but it will be possible to slip the appliance out and have a cavity inside. Take the tubing used when creating the wound, and slip the cut end through the appliance until the tube is flush with the surface of the wound.

The wound can be placed on a mannequin, or SP, with the tubing hidden under a stretcher or in clothing. Pushing the syringe will cause a bleed that has to be managed.